Dignity, Trauma, and Leadership in a Hurting World with Staci Olister and Mary Coughlin

In this conversation on The Dignity Lab, guest host and neonatologist Dr. Staci Olister brings together trauma-informed care expert Mary Coughlin and host Dr. Jennifer Griggs to explore how trauma and dignity are deeply intertwined in healthcare and beyond. They trace the evolution of trauma from a narrow focus on physical injury to a broader, lived experience that overwhelms a person’s capacity to cope. They define dignity as our inherent, unearned worth—no more and no less than anyone else’s—and extend this to organizations, non-human animals, and the Earth itself.

Dignity violations—exclusion, humiliation, lack of safety, medical gaslighting, and structural injustice—are at the root of much of the trauma experienced by patients and clinicians. Mary describes how we can “build the buffering” for people in overwhelming situations, rather than only “summing up the suffering.” Jennifer offers a pathway for reclaiming dignity: naming a dignity violation, affirming a person’s worth, seeking accountability and repair where possible, and shifting from “me” (the one to whom something happened) to “I” (the agent/creator) and ultimately to “Thou,” seeing the sacred dignity in others, including those who have harmed us.

They also address shame as an emotion that thrives in silence and secrecy. They examine how dehumanizing language, hierarchical culture, business models of productivity, and electronic health records can undermine trauma-informed, dignity-centered care. The episode closes with an invitation to join Mary and Jennifer for an immersive, trauma-informed, dignity-centered retreat in Ireland, focused on embodied leadership, radical listening, reflective writing, and nervous system regulation.

Takeaways

• Trauma is a lived experience that touches body, mind, spirit, and community
• Dignity is our inherent, unearned worth, extending to humans, organizations, and the Earth
• Trauma and dignity violations are interwoven in healthcare and beyond
• Trauma-informed care principles are practical ways to enact dignity in everyday practice
• Shame and secrecy fuel systemic disconnection in healthcare cultures
• Patients, families, and clinicians are routinely exposed to everyday dignity violations
• We reclaim dignity by naming harm, affirming worth, and seeking accountability and repair
• Healing involves shifting from “me” to “I” to “Thou” in our stories and leadership
• Dehumanizing language, business models, and electronic records can quietly erode dignity
• Presence, noticing, and community are foundations for meaningful cultural change

Exploring what it means to live and lead with dignity at work, in our families, in our communities, and in the world. What is dignity? How can we honor the dignity of others? And how can we repair and reclaim our dignity after harm? Tune in to hear stories about violations of dignity and ways in which we heal, forgive, and make choices about how we show up in a chaotic and fractured world. Hosted by physician and coach Jennifer Griggs.

For more information on the podcast, please visit www.thedignitylab.com.
For more information on podcast host Dr. Jennifer Griggs, please visit https://jennifergriggs.com/.
For additional free resources, including the periodic table of dignity elements, please visit https://jennifergriggs.com/resources/.

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Transcript

Vanessa: Hello and welcome to The Dignity Lab. I’m Vanessa Aron, the producer of this podcast. This week we have a different kind of episode in which Dr. Staci Olister, a friend and colleague of the podcast, has a conversation about trauma and dignity in healthcare with Mary Coughlin and Jennifer Griggs. I’ll let her introduce herself and get us started. Make sure to listen all the way to the end to hear about an exciting opportunity to join us in Ireland in September. 

Staci Olister: Good morning. My name is Stacey Olister. I am a practicing neonatologist in New Orleans, Louisiana for the past 29 years. And over the past several years of my career, I have had the privilege of learning from and working alongside two extraordinary women whose wisdom and kindness and integrity I deeply respect. 

I was first introduced to Mary's work on neonatal neurodevelopmental care over a decade ago. And during the pandemic, I had time to complete her trauma informed care professional certification program. More recently, I met Dr. Jennifer Griggs as she is creating a physician coaching program at the institution where I work. And I have personally and professionally taken advantage of her expertise. So it's an understatement to say that my interactions with both of them have been profoundly formative. Their teachings on both trauma-informed care and dignity have reshaped how I see myself, how I practice medicine, and how I relate to others, both personally and professionally. 

And in the truest sense of the phrase, I have been changed for good. Today, I have the distinct pleasure of leading a conversation with both of them with the goal of exploring and better understanding how their perspectives on trauma and dignity not only align, but how they deepen and amplify one another. I'd like to ground our conversation by starting with the basics, the foundations of your work, the definitions, if you will. 

So Mary, the word trauma, it can conjure up several different meanings for people. Can you start by explaining how the meaning of trauma has evolved over time and more importantly, how trauma is defined in your work today?

Mary Coughlin: Sure. So I'm glad you're kind of grounding it in clarification in the language, because you're right. Lots of folks, and myself included, kind of before I embarked on this journey, really viewed trauma as a physical event. It was a gunshot wound. It was a motor vehicle accident. I mean, kind of coming from my background as a health care professional, I thought of it very discreetly in that category. And I knew that some folks experienced traumatic events in their life, but I never really explored that and really kind got into it. It was just kind of head down and focusing on all the actions that were required when I was confronted by somebody who was in a traumatic situation. But my understanding of that concept has evolved dramatically since I've been really diving deeper into this idea of trauma-informed care and more specifically, trauma-informed developmental care. Sure, absolutely, there are physical phenomena that fit into the category of trauma. mean, medical, surgical stuff, accidents, all that kind of stuff. But if we relegate all of the human experience that is overwhelming and traumatized to just that, we're going to be missing so much suffering in the world. 

Trauma is really a lived experience that overwhelms an individual's ability to hope with a situation. It is perceived as life threatening or at least dangerous from maybe a physical perspective, but also a psychological perspective and emotional perspective. It could even be a spiritual perspective as well. So it's multifactorial. I think sometimes that's what makes it daunting for folks to embrace because it's messy. It's complex. And generally, human beings, or at least in my experience, health care professionals, we like things nice and neat and orderly so that we can respond with clarity. So that kind of evolution in my understanding really is the foundation of how I approach this work and how I really frame what it is to be and become trauma-informed.

Staci Olister: Yeah, I understand that. And even when I first started to learn about trauma-informed care, it was a bit of a mind shift for me coming from a medically trained background. Trauma is trauma. It's physical trauma. And it took a minute for me to understand that it could be more than that. It gave me a new perspective. It gave me an essential lens to understand both my own and other human experiences. So alongside trauma sits another concept equally fundamental that can also be interpreted in many different ways. So Jennifer, can you share with us what dignity means in your work?

Jennifer Griggs: Dignity is our inherent, unearned worth. Originally referring to status or merit, the word has changed over time to refer to our worth, our value, just by the very nature of being human. And over the years I’ve been thinking about dignity, I’ve come to expand dignity to include the dignity of the earth and of nonhuman animals. I also believe that organizations can have dignity and that our work can have dignity.

Staci Olister: You've both described trauma and dignity as pervasive dimensions of our experience, right? They're concepts that affect all of us. And it was through my own individual conversations with you separately that I gradually began to appreciate the striking parallels in what you were both saying and between these two ideas. So now that we've named them independently, and this is a big ask and we'll get into the details of it later, but can you describe generally how you see these two constructs aligning and relating to one another?

And now that you found each other's individual bodies of work, how have you discovered that they overlap and complement each other?

Mary Coughlin: I think from a trauma informed perspective and appreciating the unbundling that I've gone through to better understand how this concept resonates with my own lived experience, that wisdom helps me better understand how trauma, you used the word earlier, pervasive. It is a pervasive phenomenon, and I want to pick up on what you said, Jennifer, about the world at large being deserving, I'm not sure that's the right word, of dignity itself. Because, although when I began my conversation here, I really was thinking about the human experience associated with trauma, that I've also had really cool opportunities to speak with other professionals, particularly the thought is coming up to me about a conversation I had with a marine biologist and really talking about planetary trauma-informed care. And the overlap of this, right? mean, to recognize and honor the lived experience of another individual from a whole demands that we acknowledge their inherent worth, right? I mean, but…but for me to acknowledge another's inherent worth, whether they're human or non-human or nature at large, I have to be able to appreciate where I am within that ecology. I think the connection with Jennifer's work just seems so fundamental that, and interwoven, that traumatized individuals and living organisms have inherent value. And it's that inherent value and worth, the dignity that draws me to my desire to bear witness and walk alongside or do the things in a way that help other, whether other is human or non-human. I really love the complexity of this because it really just challenges how we think about our place in the world and our opportunities to be a source of healing and presence for other across every entity on the planet.

That was the thing that really kind of caught me up with Jennifer's work, that these are just intimately interwoven concepts. 

Staci Olister: You use the word deserving. And I think what Jennifer said was unearned as well. It's inherent in all of us. And I like remembering that, but it is. It's so inclusive. It's just one big circle. And it almost feels like you are missing part of the circle if you didn't acknowledge the trauma and the dignity. 

Jennifer Griggs: When our dignity is violated, we can experience trauma. And when we experience trauma, it's usually because of a dignity violation, whether it's exclusion or humiliation, lack of safety, not being seen and heard, a failure of justice, not being given the benefit of the doubt, or because there is lack of accountability.

Mary Coughlin: Mmm.

Jennifer Griggs: All of those things are alive in us when we experience trauma, whether it's medical, social, ecological, or community-based trauma. There's something in dignity that's been violated. And to restore dignity, to reclaim dignity without acknowledging trauma, I think is to compound the dignity violations. And whether it's a little t trauma or a capital T trauma, people feel that they don't matter, that the system isn't accountable to them, that they were plowed over, ignored, made voiceless. And to acknowledge that trauma happened is really the first step towards reestablishing, re-honoring, and reclaiming dignity. 

Mary Coughlin: You know, I'm going to jump in real quick because you're making me think of this quote from, I think it's Bessel van der Kolk when he kind of gives a synoptic definition of what is trauma. “It's when my reality is not seen or known.” And when you were saying, you know, that definition of dignity, that inherent unearned worth of every living being, that marginalization or for human beings, that dehumanization or minimization of my value, absolutely, it cuts right to the core of who I am. And there are situations where just that simple action of not acknowledging or seeing the you that is showing up to a situation that may be also in the throes of overwhelm adds that insult to injury.

Staci Olister: It's almost painful just to hear you talk about it. And it makes me think that this might explain a lot of the pain that people are experiencing in life, in the world, and they don't, we don't name it. We don't understand it. We don't see it. We don't recognize it. So I love that we're having this conversation. 

Some of the questions that I was going to direct you to relate more personally to our life, our work in the healthcare setting. But for now, let's take these theories that we've just discussed and maybe put them into practice a little bit. 

So Mary, our understanding of trauma has expanded, as you've explained, and it becomes increasingly clear that our work in the healthcare profession must be trauma informed. And I think that might also be a new concept for listeners to understand. Can you explain the guiding principles of trauma informed care and how they directly support dignity for both patients and clinicians?

Mary Coughlin: Sure. The guiding principles that I use as a touchstone are five. It's the concept of safety, physical safety, emotional safety, spiritual, psychological, all the ways that an individual needs to feel safety. Then there's trust and transparency. And the cool thing about trust and transparency is it also is connected to safety, right? If I trust you, if you are transparent, It builds my sense of not only trust, your trustworthiness, but it also helps make me feel safer in relationship with you or in your presence. The next one over is healthy relationships and interactions. Well, gee, Willigers, a healthy relationship and interaction is the cornerstone of that is trusting each other, right? Trusting the nature of the situation. It doesn't mean that you're not gonna like fumble and, mess up occasionally. But when that happens, repairing that rupture and those kind of cyclical experiences also, again, continue to build and strengthen a sense of safety and a sense of trust and transparency through our relationships. And then the next kind of evolution of that then is then that sense of empowerment and voice and choice. If I'm in a healthy relationship with you, then I feel like I can speak, I can be heard, I can be seen. That makes me feel even more trusted in your presence, which again builds up that safety muscle. And then the final one is about equity and anti-bias efforts and cultural and gender affirmation. I see all of you, all of who you are, not through some lens or some prescription. And when I feel seen like that, that makes my voice feel free to engage in conversation. It really solidifies that this is a really healthy relationship and we can have healthy interactions. It doesn't mean we always agree, but that I feel safe in your presence to even disagree because I trust you because we built this foundation. So even though you can kind of list them linearly, they're so wicked interconnected. And I think that those elements really are the the quintessence of how we can walk alongside individuals who are experiencing overwhelm. And we can use those principles as actual strategies to help the individual that we're walking alongside feel safe, feel seen, feel empowered, all of the things. Even in the course of the do's that we have to do in a medical situation, right?

Those actions are colored by the me who shows up to that, right? I mean, I'm not a robot. I'm not a, you know, yeah, a robot. I'm a living, breathing human being who has had my own lived experience. And so the me that shows up to you needs to be mindful, aware, present.

I draw from my own experiences of overwhelm, fear, isolation, all of the things so that I can, with intentionality, show up. Not like a cookie cutter or a Stepford wife kind of a thing, but as someone who understands, I've learned from my own lived experiences and I'm gonna use that wisdom to help you navigate this event, whatever the situation is that's unfolding.

Whether you're an adult, right? Whether you're the parents of this, you know, because we work in neonatology, or least Staci and I do. Whether it's… that the family, whether it's that tiny little human being who's figuring out what it is to be a human being. That first year of life is all about trust versus mistrust, you know? Do I have to be scared for the rest of my life and wait for the next shoe to fall? Or am I really safe? And our colleagues as well who are...help bring their own story, but are also bearing witness to catastrophic events, tragic events that, you know, they touch our hearts and souls and they can cause injury to us as well. So it's all of those elements.

Staci Olister: I agree. And in the pediatric literature, I've learned the term a relational health approach. And that sounds like what you're describing is that medicine is not simply, I am dictating medical care to you, but it's a relationship that we're establishing. I think the hard part to get around is, yeah, it takes some work. You might have a heavy lift on the front end with both yourself and changing your practice, but the relationships that you have with your patients or your coworkers after the fact makes it more than worth it…

Mary Coughlin: Mm-hmm. Yeah.

Staci Olister: 

…if that's the environment you're working in. And in those environments, Jennifer, that we've all worked in, I think we have all both witnessed and experienced painful collision of dignity and trauma. And I think there's even a tendency to underestimate our own injury and our lived experiences. Can you shed some light here by maybe describing some common ways that dignity is violated in healthcare that we might not even recognize as abnormal or a violation or potentially painful?

Jennifer Griggs: The most important thing to understand is the role of asymmetry of power in violations of dignity. The power asymmetry between those working in the healthcare field and the people whom we serve puts patients, families, other loved ones, and communities in a position where they are more vulnerable to harm. When people are sick, they are vulnerable. Then add to that the asymmetry in power, and it’s easy to see the many ways in which healthcare violates dignity. 

Medical stigma, lack of safety, exclusion of people and groups, a lack of attentive listening, lack of validation of people’s experiences, medical gaslighting, a lack of accountability and repair of historical and present day harms in the healthcare system, injustice, and violations of people’s autonomy are all ways we violate the dignity of our patients and their families.

Then add to that the violations of dignity in the workplace. The power that systems have to violate dignity and to do so without accountability is hard to ignore. It’s hard not to see. When we don’t bother to pronounce someone’s name correctly or give them a nickname, when people experience workplace violence, when people are not recognized for their contributions and their striving, when people don’t have autonomy in the workplace…all of these are violations of dignity that I see are rampant in healthcare work situations. 

Staci Olister: I agree with you once you see it, it's easier to recognize. I think it is as surprising and counterintuitive to a lot of people as it was to me that trauma occurs in the healthcare setting, because this is a place that people come to heal. It doesn't make sense. And I agree with you that I think it's because not only are dignity violations not recognized and they're not labeled as traumatizing, but they're even, you said gaslighting, they're normalized. This is what's expected in the workplace especially when you're in a very high pressure environment or as she said that hierarchical culture of medicine in which structural authority and power dynamics are inevitably present.

To make this more relatable and maybe to appreciate how it plays out in real moments, you mentioned your own personal experience, Jennifer, but as a physician and a physician coach, are there other examples that you can share where someone's, where restoring someone's dignity was critical? Moderators excluded, please.

Jennifer Griggs: Restoring dignity is surprisingly simple. By acknowledging people’s experience, by slowing down to listen, by including them in decision making, by giving them autonomy, by promoting fairness, we can restore dignity. Particularly key is the element of accountability, in which people acknowledge when harm has happened and work to make things right, or at least as right as possible. People really just want to feel that they belong, that they are seen and heard, and that things are fair.

Mary Coughlin: Mm-hmm.

Staci Olister: Yeah, agree. Everyone wants to be seen. And I wonder, you know, these conversations about trauma and dignity, again, they were news to me later in my career. And I think especially the melding of these two concepts are gonna be news to other people, if you will. And I wonder why it's taken so long for them to surface openly and for us to have this discussion non-judgmentally. And I have read that it's probably because in part, they are shaped by an emotion that thrives in silence…

Mary Coughlin: Yeah. Mm-hmm. Yes.

Staci Olister: …and that's shame. Shame on the receiving end because you think something's wrong with you. And shame on the giving end, as you just explained, maybe that was the physician's reaction. So Mary, can you offer your insight on the role that shame plays in dignity violations and trauma and how incorporating trauma-informed care practices can not only address but counteract that shame?

Mary Coughlin: Yeah, you're absolutely right in calling out shame. Wow, that's a really profound observation. I think to kind of really address that, what's coming up for me is the thought that just how we are socialized, how we are encultured into this current society is very intentional of keeping people in their place, keeping people aligned with their silos aligned with their responsibilities and in effect to keep people disconnected. This is my take on it. Okay, but when you keep people disconnected and and we are a social species by nature what it does is it it creates this sense of isolation that then is intimately connected with fear, and so for me to speak out about something that has not been sanctioned, if you will, right? And there's so much in the world that is taboo, right? I mean, when we talk about inequities in healthcare, when we talk about, I mean, obstetric violence, when we talk about, you know, and maybe general medical violence, when we talk about these things, it's always, you know, behind closed doors, very quiet, because we know that it will...it will activate a response that will make people feel wicked bad. And the system wants things that way so that they can continue to perpetuate this hierarchical approach to how we govern or manage human beings, keeping them all in there. And it's a huge dignity violation for sure. And then the other thought that came up to me was just like that difference between feeling shame and feeling guilt, right? That shame is a feeling that is like it's intimately connected to who I am. It's my essence. And so that makes me contract incredibly. 

And so in the throes of, say, for example, clinical example of being in the NICU, but I also have this other identity. Maybe I'm a person of color. Maybe I have other types of you know, parts of my story that don't fit the mainstream storyline, if you will. I feel like I'm feeling shame because I need to figure out how I'm going to show up in a way that is going to resonate with the majority of folks that I'm with, that then continues to amp up my trauma because my reality is not being seen or acknowledged in any way, or form. And I have to play along. So that's, I mean, that's like a double punch of dignity violation, right? And it's also a trauma compounder as well. Because shame has big power because it is held in secrecy. Trauma and the residual effects of trauma are also kept in the shadows. We don't talk about this, just from my own lived experience, I think I'm Olympic level stuffer. I will stuff stuff until the cows come home because I have been taught that no one wants to hear that story. No one wants to do what when I speak, my goal is not to make you feel bad. And that adds to the shame piece, right? I mean, if you, if my whole job in life is to make you not feel uncomfortable, there's a lot of me that is going to suffer as a consequence. So kind of disentangling that and that is for me that is so representative of the dignity violations that you're speaking of Jennifer that if I can't be me, if you're telling me my job is to make you feel comfortable, then I have no value. I have no worth except how I can make you feel good.

And we do this in clinical situations, right? I… I hope I'm not getting too off track here, but it's that whole thing of like, you know how I'll think about the NICU, right? And if parents come in, family comes in and I'm doing my dues, you know, I'm changing the lines, I'm doing whatever the heck I'm doing, right? And I just naturally say, how are you? To be honest with you, I'm not expecting a response. And most people know that. That's the game. Because they're looking at me and if I really wanted to know how you are, I'd pull up a chair. I'd sit down next to you. I might even make you a cup of tea and just like lean in. But we say these things to make you feel good on the surface. But what it does, because I'm not really opening the door, it keeps you small. keeps you feeling those feelings of shame and isolation and all that kind of stuff. Is that making sense? 

Staci Olister: Yes, it's reminiscent of my personal conversations with Jennifer where she was helping me find my worth and find my true self so that I could be present for other people. And my own experiences with trauma and microaggressions and dignity violations, they were, they spun me. They were deeply disruptive. And even more so because I didn't understand what was happening at the time. I thought I did. I thought something was wrong with me.

And so I've come to understand myself a lot better from having worked with and learned from both of you. And I continue to recognize these situations and I self reflect and I use that self awareness to, and one of you mentioned this, respond rather than react because we can be very reactive, I think in these high pressure situations, these difficult predicaments. You are both teachers, mentors, role models. 

So Jennifer, I will ask when dignity is lost, when you're feeling it, what advice or what actions could you offer to someone to reclaim that dignity amidst those violations or amidst the power differentials or systemic barriers that we face?

Jennifer Griggs: There are several key steps in responding to a dignity violation. The first is to name it as such: this was a dignity violation. Knowing the elements of dignity that were violated is also helpful. The second is to affirm the value and worth of the person who’s been hurt. No matter who they are, no matter what has happened to them, no matter what they’ve done, they have worth and value. No more and no less than others. The third is to repair dignity through accountability. I have to say, and you won’t be surprised to hear this, nor will our listeners, that this is not particularly common in systems, in situations where there are differences in power. 

So what do we do if accountability and repair are not likely to happen? Can we still heal? I believe that we can. I believe that we can shift from “me” to “I.” What I mean by this, and Donna Hicks describes this beautifully in her books on dignity, in turn borrowing this from the philosopher and psychologist William James, is that we move from being the object of the story–the person to whom something happened–to the subject of the story. In the drama triangle, this is moving from the victim to the creator. The creator is the author, the artist, the storyteller. The victim is the object of others’ actions. The creator has agency, has choice.

Part of this is taking responsibility for our own role in a given situation. This can be hard! For some people, such as a neonate, they had no agency. That’s not what I’m talking about here. I’m talking about our role in a system, a relationship, an organization. What can we take responsibility for? 

In addition to taking accountability and repairing harms as we move forward, we can also choose how we set boundaries around what is okay and what is not okay. We can also serve as advocates or activists, speaking for those who don’t have a say.

What I’ve been thinking about recently is that, ultimately and eventually, we can move from “me” to “I” to “Thou.” This is what happens as we heal and then begin to see the dignity of others, even those who hurt us. In my work with people who have been hurt, this shift is one of the most restorative and healing moves. As an example, a man I worked with was able to identify the elements of his dignity that his ex-wife had violated. He was able to see the ways in which he violated his own dignity in his responses to her. He was then able to see the ways in which he had violated her dignity and, here’s where true transformation happened, was able to see her dignity. It was only then that he was able to be free from a decades-long hurt. I’m not sure this is what happens for all of us, but this is what I mean when I talk about “I” and “Thou,” seeing the sacred in the other.

Staci Olister: Those words are, yeah, huge. Those words are very impactful and I'm witnessing the impact it's having on Mary right now because I have the benefit of seeing you on camera. And I want to ask you a question, Mary, that you were alluding to and that is, can you speak to the impact that fostering dignity, recognizing this and other persons and fostering belonging and not fitting in…

Mary Coughlin: Yeah.

Staci Olister: …can have on people who have experienced trauma.

Mary Coughlin: Yeah. Gosh, I'm so glad you brought that up. So in this work, in trauma-informed care, and specifically in pediatrics, I've seen different organizations talk about being trauma-informed isn't about summing up the suffering, but it's building the buffering. And I really liked that. I really liked that concept. And so it made me start kind of thinking about like,

Okay, okay. So what does it look like to be a buffer? How do you buffer? What is buffering? And you know how you kind of get weird and you dive into all that stuff. And I do love a good acronym. So I started thinking about it from that buffer perspective. And you mentioned belonging. And I think that is such a core quintessential human need to belong, to feel like you belong. I mean, to feel like you belong, there has to be a sense of safety, all the different kinds of safety, healthy relationships, trust and transparency, empowerment, voice and choice, equity, and all of those other elements. It's uniquely different. And you ask folks, what does it feel like when you feel like you belong? Like when you belong in your family or you belong in your community, what does it feel like? And then to juxtapose that feeling of safety and security, to what does it feel like to fit in? And to be honest, I hadn't really thought a lot about the distinction, but through this clarity of really looking at the words and sensing the feeling of it, that embodied sense of the safety of belonging, and then the stress of fitting in. The fitting in is kind of what I was mentioning before. It's like, my job is to make you feel comfortable, and I shouldn't say anything that makes you feel uncomfortable. I'm fitting in. I am subjugating my own worth to defer to your value because clearly you are more valuable than I am and how that gets wired in and it adds to self-trauma as well. And so kind of going through the buffer, it's like, the belonging piece is essential, it's elemental. And the next element of it is understanding. And in order for me to understand anything about you,

It really starts with understanding who I am. I mean, and to me, it's kind of this like discovery, like an aha moment of like, my gosh, you the better I understand me, the better version of me can show up to you. So really understanding what are my triggers? What really be more intentional and aware because I don't want to react. I'm really good at reacting, but I noticed that when I react, it's not my best self. And oftentimes I can hurt another person, not in a powery way, like not, you I'm not hurting you because you're more important than me. I'm hurting you because I'm operating from my brainstem. I'm not really present to what's unfolding. And then the two Fs, well, the first one is forgiveness. And it's wicked hard for me to forgive you if I can't even cut myself slack. Like I have to practice. And I'm harder on myself than I am on anybody else. So even if I can get a little bit better for myself, I'm going to be way better for you. Do you know? I mean, that whole thing, we make mistakes. Embrace our foibles and our frailty as human beings. Embrace that. And be aware that, I mean, I know it's never my intention to hurt anyone, but I need to own that I made a mistake and believe in the trust of you. I might be, you know, maybe you don't trust me anymore. And I'm going to work at that. I can't change that, but I need to, I need to trust myself again. And I do that through forgiveness and frameworks. I mean, frameworks are awesome, right? Because we work in an evidence-based world, you know? And so there's lots of wisdom and frameworks and structures that I can use as touchstones. I'm not the first person that's walked through this thing called life.

I can learn from other people. There are other resources for me that can help ground me. The E is about equanimity, finding the calm in the chaos. And when I think of equanimity, you know what I go to, you guys will laugh a little bit, is when I have to be at the head of the bed. In the NICU world, when you're at the head of the bed, you're the person that's doing the intubation. And that's wicked scary, and you can't be freaking out. And so finding that calm and that confidence within that I can do this. And I've got a trusting team around me, you know, practicing that. But it doesn't just happen, I mean, a lot of these skills do kind of pop up every now and again. But the beauty of it is, you had mentioned this earlier, once we start naming things and seeing them on the outside, we can actually be more intentional and action oriented about like, you know, like it's like going to the gym. I'm going to build that forgiveness muscle. I need to practice belonging and understanding. And then the R is respect. And I liked, Jennifer, how you had mentioned about respect. For me, respect is really just that acknowledgment about the inherent dignity of every human being, of every living entity on the planet. And it spells buffer instead of buffed. Buffed.

Mary Coughlin: Yeah, oh, we might have to go back to the drawing board. This is, this sounds pretty cool because being buffed does some fun.

Staci Olister: I liked the analogy that you made with being at the head of the bed in neonatology, because one thing that I tried to teach to the learners I work with is not just how to intubate when you're at the head of the bed, but that the calmer you are when there's craziness around you, yeah, it just, kind of instills the whole environment. I think it's a good teaching point, but certainly individual intention. 

Jennifer Griggs: That reminds me, that reminds me, Staci, of the eight C's of the self leadership mindset, the head of the bed being calm and clear, curious, compassionate, courageous, confident, connected and creative as leaders of ourselves or in our families or in the workplace to maintain all of those qualities is being at the head of the bed.

Staci Olister: That's a nice way to describe it. If you know, you know. But certainly individual intention is paramount. We know that. Let's expand this to a wider perspective because the systems that we work in often determine, if you will, to some extent, what is possible. So I would like you both to take a stab at what do the policies, the language, communication, any other systemic barriers that we may experience in the healthcare setting that undermine trauma-informed, dignity-centered care, and how can we address those barriers?

Mary Coughlin: I mean, the lexicon coming right out of the gate is very dehumanizing and disrespectful and is just full of dignity violations when I think of when we refer to the babies as their diagnosis, when we label families as difficult. 

We blame the patient. So they failed extubation. It's not my fate. I was all set. I don't need a tube. You failed extubation or a myriad of other things, because I've heard this same type of language in other clinical settings. Although neonatology is my comfort zone, I know that this transcends all medical environments. Again, it's this language that keeps us separated, keeps us disconnected. And unless we really start to call it out, name the things. I mean, you know, there's just, did the baby tolerate their feeds? Is that the goal? I mean, where the heck is the bar? You know, I mean, cause I mean, when we go out to dinner, it's the most important thing is that we tolerate the meal. I mean, enjoyment is not even on the radar, right? I mean, you just think about the goofy things that we say that devalue and are dignity violations of the integrity of the wholeness and the sacredness of the babies, of the families, of each other and of ourselves. 

I mean, that was kind of the takeaway, Jen, when you were saying about what dignity is and you went from the...me to I to we to thou, it felt so sacred. And we need to re-inject the sacredness of the work that we do and who we are back into our lexicon, not just in healthcare, but I think in human care, you know, in all of its...know, various shapes and patterns.

Staci Olister: What you're saying to me, Mary, yes, that I'm gonna put on my armor, I'm jaded, I'm gonna show up, I'm gonna use the terms. It's almost a hazing atmosphere. And it's almost that we're girdering ourselves, girding ourselves, we're armoring ourselves to go into that environment that we are personally traumatized in. It's just such a circular argument that until we as clinicians recognize that we are traumatized as well by these very painful experiences…

Mary Coughlin: Mm-hmm. Mm-hmm. Yes. Mm-hmm.

Staci Olister: …whether intentional or not, we're not blaming anyone, but it's just the truth of our work in healthcare. Jennifer, you have any thoughts?

Jennifer Griggs: I think what's alive in me now is an invitation to curiosity. What is this experience like for you? What is your illness representation? What is going on with you in this moment? What stories are you telling yourself? What is it like to be you? It feels like we could go a long way with those questions.

Mary: Yeah, yeah, for sure.

Staci Olister: You mentioned, you alluded to something like this, Mary, that, and for me, these topics, these conversations fall into the, once you see them, you can't unsee them kind of thing. And so the next question becomes, okay, so what can one person do really? Am I gonna have any effect when I see trauma and dignity violations around me? And certainly my personal accountability, my individual work, any grassroots effort, these are all admirable. These are all important.

Mary Coughlin: Mm-hmm. Yep. Mm-hmm.

Staci Olister: But when leadership centers dignity, there could be a lot more traction gained. There could be a bigger shift in the culture. So I would ask how that leadership could begin to transform some of the toxicity we may be experiencing and how can we get leaders to see that work as essential.

Mary Coughlin: Mm-hmm. Yeah. I mean, that's really the turnkey, right? Is to get buy-in. And I think one of the things that I've kind of learned on this journey is never underestimate the power of role modeling. I think sometimes you can feel kind of invisible, but people are watching you. People are watching everyone all the time and are taking conscious note and unconscious notes of how you're showing up to different situations.

And I think certainly it's not just a one-pronged approach. Really continue to build your own skill set. Build the muscles that you have to show up and foster belonging, safety, trustworthiness. Be compassionate. Be forgiving. Be the calm in the storm. Ratchet down the dignity violations and really start to see others as they truly are.

But, and you work on that for yourself. I mean, that's the cool thing, right? You're the practice, you know, you're the gym, you know, you can do all of this stuff with yourself and you still win, even if you can't convince the grumpiest gurdy in the room, you still win because you're building your skills and other folks are noticing. But then also, you know, there are different tools out there that help us begin to take an assessment of the culture in the space and begin to raise awareness of, how are you feeling? And how are you feeling? I say this with caution and recognize that it is wicked hard, but we have this thought that we need business models to manage human centered care. And what these business models are doing are they're stripping the human right out of it and setting us up for failure because business models are about productivity, they're about performance, they're about extraction. And when you're pushing people to perform and to experience that extraction, I mean, I'm going to keep you in this position until you cry uncle and squeeze every last bit of humanity out of you. And then what's left are these husks of just...well, grumpy girdies, you know, and a lot of other languages that we can use to describe these shells now of their former selves. And they can do the tasks, but what's the experience of care? And if we can approach this work of fostering trauma-informed cultures that are rooted in dignity and rooted in equity, then we actually can make such a big impact on metrics that hospitals pay attention to, but also invite them you might want to look at some other metrics as well. Because if you're counting all of your impact on these, what do call them? The press gainies or the patient satisfaction scores that have such a ridiculous low turnout. I mean, how many patients do you see? And what do you see? 10 % return? Maybe. And that's what you're basing your whole model on? You might want to go back to the drawing board and re-examine the metrics for your success.

Because you're not succeeding. You're faking it. know? I know, no qualifications here. But I think really it takes, but what we do is we build community. Are you feeling this? I'm feeling this. Are you feeling this? I'm feeling this. Because as disconnected as we are, there are shared experiences that if we can come back together, just like in any other challenging environment, in community, there is power. And we can shift the tide if we can take back our dignity and our power to really affect change and to lead with our values, you know, and not sacrificing our moral integrity. Let me get off my soapbox now and come back down.

Staci Olister: Jennifer, what do you think, what can leadership do for us? How can we convince them that this is a necessary endeavor and that we are not simply becoming the dried out husks that Mary just described and becoming replaceable by the next fresh meat behind us? What can we do to change it?

Jennifer Griggs: I think storytelling is probably really important here. Data, large data sets, press Ganey scores are one thing, but storytelling brings experience alive. I think we need to take courageous accountability. We need to say we've messed up. We've excluded people. We've harmed communities. We have baked in structures that it's not a bug, it's a feature of our system that we put profit before people.

I think we have to take courageous accountability for individuals. I think we have to be consistent and stay calm. You know, as you're talking about leaders leading in a dignity- informed way, I'm thinking about other leaders and wondering what would happen if leaders who do great harm actually knew that they had value and worth. And so did everybody else no more or no less. So I think we have to treat our leaders as if they have value and worth, which can be really hard in the face of terrible, terrible behavior.

Mary Coughlin: Amen.

Staci Olister: Yes, this is hard work. It's demanding. It requires presence, humility. And I almost, in terms of teaching our young learners who are coming behind us, I place this education, this value, learning the importance of these in that bucket of soft skills. I've come across this term recently, right? They're not diagnoses, they're not algorithms, they're not procedures, they're soft skills, almost the Cs that you were just commenting on. 

Staci Olister: Sometimes the people you're working with at present, what do you call them? The early adopters, you might catch a few of those, but I'm focusing on the people coming up behind us. Like Mary said, if we can role model for them and teach them, I think that's gonna be our biggest payoff. I don't know.

Mary Coughlin: Mm-hmm.

Jennifer Griggs: Can we call them essential skills and not soft skills?

Staci Olister: Absolutely. I'm just telling you what's in the literature. I did not name those.

Mary Coughlin: Yes, I was thinking something similar, Jennifer.

Jennifer Griggs: I know. And there's there's a cry of the heart to call them essential. When I when I talk with patients and hear think about well, I just invite you to think about an encounter you had with a clinician that didn't go well. It's rarely the technical aspects of care. It's how you were talked to by the front desk staff, whether it's in a way that honors dignity or violates it. So I think these are essential skills. The EHR alone is one more dignity violation because it disconnects us from each other to speak to Mary's call for connection.

Staci Olister: As we come to a close, I'd like to leave our listeners with something they can carry forward. And I have two final questions for you. The first is, what final invitation or call to action would you offer to those who want to lead in a trauma-informed care way, wherever they are? Maybe in the medical setting, maybe not, but what words of wisdom can you impart here?

Mary Coughlin: The word that jumps up to me is about noticing. I think everything kind of starts there. If you start to notice how you feel in different situations, it helps ... I'm envisioning this like priming the pump. It helps you become more present. When you become more present, I think, Jennifer, you used this word earlier, it opens the door to be curious, it kind of noticing, you know, it's kind of a conscious thing. And so you're, know, you've kind of taken the elevator upstairs. You're not reacting. You're reflecting. And I think, you know, the more you can notice and see the things that have historically not been named, you can then identify them. And once you begin to notice them, like you said earlier, Staci, you can't unsee them.

And then that begins to, I think, mingle and mix almost like, what do you call it, like alchemical magic almost, that reactivates your moral integrity. Your values get like, they start to glow. Like, I know what that feels like. I know that. That's who I am. But we oftentimes, I think, walk through life kind of blinders on, head down, getting through things because it's all about productivity, but wouldn't it be wicked cool to just flip the switch and make it more about presence? And so I think if you can just practice that by noticing little things, how you feel, and that's all. No more homework assignment because that will begin the domino effect of noticing more and noticing opens the door for your curiosity and reflection.

Jennifer Griggs: I would say never forget, or relearn, re-remember that you are a child of the universe, no less than the trees and the stars and so is everybody else around you.

Staci: And so my second question for the two of you is how do you see the combined efforts of your work continuing to flourish, to progress? Can you offer us any insight into plans that you may have?

Jennifer Griggs: So this is an invitation for you, our listeners, to join us in Ireland. Mary and I are co-creating a three-day retreat with a little time on either end with an artist in residence, Jessica Brown. We are creating not a conference, not a symposium, not a workshop, but an experience where those of you who join us will be in a quiet, beautiful place with access to forest fields and paths, a small group of peers, people who are in caring professions, however you define that. If you care for other people, you are in a caring profession. And we are going to have daily embodied practices. We're going to have poetry. We're going to have time to regulate your nervous system. We're going to have time in silence and we're going to be learning together. No experts here. The principles, practices and experiences of radical listening, reflective writing, even if you don't consider yourself creative, storytelling, including myth and fairy tale, nonviolent communication, living and leading with dignity, embodied leadership, playful intelligence, trauma informed leadership, and a session we're calling Leading From Home with good food and a lot of laughter, trauma-informed practices with a great awareness of anti-racism to the best that we can. And we would love to have you join us.

Mary Coughlin: It's gonna be absolutely amazing.

Jennifer Griggs: Registration’s open now. Yep, and we'll have a link to the website where you can sign up to come in the show notes.

Staci Olister: Amazing.

Mary Coughlin: Yay!

Staci Olister: So as we do come to a final close, I would like to pause and just comment on what my interactions with both of you have made very clear to me. And that's that trauma and dignity are not abstract concepts. They're lived experiences and they shape how we care for one another, especially in moments of vulnerability. And what I'm hearing as you gave your closing comments is awareness and noticing, curiosity, recognizing our own self-worth, standing in our moral integrity. Just being present and humble can sometimes lead to very meaningful change. But I hope that anyone listening isn't burdened by all of these asks, that these are not layers of work that you have to take on, but that they rather feel invited to do all these things and lead with dignity in whatever role they hold and in whatever setting they're in. So thank you both, Mary and Jennifer, for sharing your wisdom and the work that you continue to do in the world. And thank you to everyone for listening and being part of this conversation.

Vanessa: We hope you’ve enjoyed this special episode of The Dignity Lab with Staci, Mary, and Jennifer and our discussion of trauma, dignity, and leadership. The Dignity Lab is taking a couple of weeks off and will be back with Season 6.